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Plain language for living with HS

Double and tombstone comedones in hidradenitis suppurativa

Double comedones are two nearby or connected dark follicular openings, also described as double-headed or double-ended. Tombstone comedones is another HS-associated label for open, scar-related plugs. These terms appear in hidradenitis suppurativa literature but do not replace an in-person skin assessment.

Also called: double-headed comedones · double-ended comedones

Patient-written, checked against the listed sources, and not medically reviewed. Educational information, not personal clinical interpretation.

In the HS context

Double or tombstone comedones

The paired or scar-linked configuration is more HS-specific than one ordinary blackhead.

Why several names appear for a similar feature

HS publications use double-headed, double-ended, and tombstone comedones. Double emphasizes two nearby openings that may connect beneath the surface. Tombstone emphasizes an open plug associated with scarring. The terms overlap in HS writing, but authors may not use them in exactly the same way.

Why one blackhead is a different question

An ordinary comedone is common in acne and can appear without HS. A paired or scar-linked opening becomes meaningful only within the larger history: recurring deep lesions in characteristic areas, drainage, tunnels, and scars. One visible feature cannot establish that broader pattern.

What to record without manipulating the skin

Note when the openings appeared, whether they changed, and whether the same area previously had a deep lump, drainage, or a scar. Record other paired openings nearby. Avoid squeezing or probing the area to test whether the dots connect; simple observations are enough for a more precise appointment conversation.

How it may be described

  • They may look like two black dots connected beneath a small bridge of skin.
  • They can sit near scarring or an area with earlier nodules and drainage.

Do not automatically confuse with

Single comedone. One blackhead is common and does not carry the same descriptive specificity. ↗

Prepare a more precise conversation

Details worth bringing to an appointment

  • When did the openings appear and has the area had deep or draining lesions?
  • Are scars, tunnels, or other paired openings nearby?
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Sources

Checked: August 9, 2026. Patient-written, checked against the listed sources, and not medically reviewed. Educational information, not personal clinical interpretation.